Keeping our front‑line staff safe from Occupational Violence

Seven years ago this month, the QAS partnered with our sector union, United Workers Union, to deliver its first report on Occupational Violence (OV) to the government in response to growing concerns for frontline staff exposed to aggressive treatment while either out on the roads, or over the phones.

Deputy Commissioner Stephen Zsombok said one of the 15 key recommendations from the 2016 Paramedic Safety Taskforce Report was to establish a joint consultative group of the QAS and United Workers Union (UWU) to meet regularly to provide high-level advice, oversight and governance in relation to current and future strategic and operational planned strategies, systems and processes to minimise the risk of occupational violence to our QAS personnel.

This group, now known as the Preventing Occupational Violence Management Committee, has been extremely proactive in its focus on this risk and is committed to looking into all avenues to realise a continual reduction of harm to our staff. Even now, it continues to monitor and improve strategies to protect our frontline staff.

“The assault on any of our staff, whether it’s physical or verbal, and whether it’s intentional or not, is inexcusable, unacceptable and unlawful behaviour,” Steve said.

“The QAS continues to maintain a zero tolerance approach to occupational violence and is committed to promoting a safe culture for our workforce.

“Every single one of our frontline workers has the right to feel safe and respected when they’re out in our community or in our call centres as they perform their daily duties, and the Committee is continuing to monitor QAS’s violence prevention strategies to look for any improvements we can make.”

OV, or work-related violence and aggression includes any incident where a QAS worker is abused, threatened or assaulted by a patient, their relatives, or any member of the public while working for the QAS, irrespective of any intent for harm.

Examples of this range from physical assault; including biting, scratching, hitting, kicking, pushing, shoving, tripping, grabbing, throwing objects or using a weapon, and can also include coughing and spitting at staff, and aggressive behaviour; including verbal abuse, threats and angry and hostile behaviour, intimidation and insults, and shouting –whether in person or over a device.

It also includes sexual assault of indecent physical contact.

Whether the OV is intentional or not is irrelevant, the main issue is the behaviour creates a risk of physical or psychological harm to QAS staff.

In 2016, the OV Management Committee implemented recommendations made in the Report, including;

• reviewing our Situational Awareness for Everyday Encounters (SAFE) training and rolling out a revised Occupational Safety Training (OST) course to all frontline staff

• developing and implementing a media and communications strategy and campaign (both internal and external) to minimise violence against paramedics

• reviewing data and developing demographic modelling to identify situational factors contributing to OV against paramedics and to ensure ongoing data collection and analysis.

• reviewing our operational processes to improve post-incident reporting and support pathways which also included developing a Directive and Guidelines to be incorporated into the QAS online education and the occupational violence focused training program

• reviewing QAS clinical practice and patient safety guidelines to include a graded approach to managing acute behavioural disturbances

• chemical sedation was introduced into clinical practice to enable ACPs to treat patients presenting with this behaviour.

• researched OV related literature, identifying potential positive interventions for QAS use.

• investigated potential technology options to also potentially reduce OV risk.

Steve said the rate of incidents have continued to reduce gradually after the recommendations were implemented in 2016.

In 2021-22, the OV Management Committee reviewed QAS’s prevention strategies, with the outcomes including:

• continued mandatory Occupational Safety Training for all new paramedics as part of their induction, and refresher training for all paramedics.

• continued training, educating and informing Advanced Care Paramedics and Critical Care Paramedics to safely administer droperidol for patients with acute behavioural disturbances.

• raising awareness surrounding occupational violence through external

Pimpama-based paramedic media and internal messaging, where there is ‘no excuse for abuse’ and to ‘respect our staff'.

Brad Johnson’s story saw OV in the international and national media spotlight after a drugaffected patient brutally attacked him while he was on a night shift just before Christmas in 2015.

While cases and QAS’s concern about OV had been growing, Brad’s shocking case became the catalyst for major change in our organisation, with the Paramedic Safety Taskforce Final Report delivered to the Health and Ambulance Minister in April 2016 and its recommendations implemented by the end of 2016.

• implementing mental health clinicians within the Brisbane Operations Centre to provide statewide support to Queensland Ambulance Service staff when responding to patients suffering a mental health crisis. These clinicians can access Queensland Health and Queensland Police Service information to maximise paramedic and patient safety.

• monitoring the operation of duress and location functionality in ambulance vehicles fitted with satellite push-to-talk radios.

• integrating real-time messaging to the Queensland Police Service through the Inter-CAD Electronic Messaging System.

• recording caution notes in the Queensland Ambulance Service’s Computer Aided Dispatch system to inform paramedics when there is a potential risk of violence.

• providing access to specialist staff support and counselling services through the Queensland Ambulance Service’s staff support service, Priority One.

• encouraging the reporting of all assaults to the Queensland Police Service for appropriate investigation.

• building the capability of staff to undertake investigation of occupational violence incidents to minimise the risk of reoccurrence.

• researching contemporary literature to identify best practice strategies to minimise occupational violence risk.

Steve said QAS supports its Paramedics, Patient Transport Officers, OpCen and all QAS staff through sound risk management practices and processes, skills training and the use of modern technologies to minimise the risk of occupational violence.

He said the Queensland Police Service, not the QAS, determines what constitutes an assault.

An assault on a paramedic in Queensland is considered a serious assault and carries a maximum penalty of up to 14 years imprisonment under the Criminal Code Act 1899.

QAS’s Workplace Health and Safety unit Executive Manager Paul Coffey was 2016 Paramedic Safety Taskforce secretariate and still oversees the development, implementation, and management of the QAS Workplace Health and Safety Management System, including safetyrelated incidents and workers’ compensation claims specific to occupational violence.

Paul explains how our OV rate is measured…

The QAS publishes quarterly Public Performance Indicators (PPI) on a range of indicators including ‘Care of Staff’.

Under this PPI is a specific indicator known as ‘Occupational Violence Staff Safety Index’ (formerly known as ‘Crew Safety Index’).

This index provides an indication of the rate of exposure of operational personnel to deliberate physical violence and verbal abuse by patients and/or bystanders.

This is calculated as the number of reported cases of occupational violence (recorded within the Safety Health and Environment (SHE) reporting system) per 100,000 hours worked (calculated as the sum of all hours worked inclusive of overtime and leave).

At the end of the financial 2015-16, the year that the Paramedic Safety Taskforce was established, the QAS Occupational Violence Staff Safety Index was recorded at 6.5.

In comparison, at the end of financial year 2021-22, QAS Occupational Violence Staff Safety Index was recorded at 4.1.

This represents a 36.9 per cent decrease over a 6-year period.

While a reduction in the Occupational Violence Staff Safety Index is a positive result, when talking occupational violence, one incident is always considered one too many.

In late 2015 the United Workers Union and QAS collaborated to ensure the public heard unified messaging about keeping our front line workers safe.

UWU Ambulance Sector Lead Organiser Debbie Gillott and Delegate and QAS paramedic Leisel Cahalan said the union was keen to protect QAS workers and its partnership in the Zero Tolerance public awareness campaign was integral to this.

“Like everyone, we were horrified by Brad’s injuries, and we were pushing for greater awareness around OV for not just our paramedics, but also all front line workers,” Debbie said.

“We’ve had a close working relationship with the QAS and our partnership with OV certainly continues, and we still survey our members to ensure we can feedback to the QAS our findings.

“More recently our workers have been working to ensure our frontline workers in the Operations Centres are better supported when it comes to OV too as verbal abuse and aggression can be incredibly powerful also.

“We contact our members if or when they report OV and make sure they feel supported – we also recognise we’re one of many links within QAS who do reach out which we are pleased about – including staff managers, Priority One, Peer Support or Chaplains.”

Leisel said while a lot of improvements have occurred over the last seven years, it was good to see work is still ongoing and improvements are continuing to be made to prevent OV to frontline staff.

Most QAS call-takers have a story about some of the abuse they’ve received over the phones.

They understand most of the calls they take each shift are from people probably experiencing the worst day of their lives.

According to Cairns Operations Centre Executive Manager Brina Keating, staff regularly receive highly emotive and verbally abusive emergency calls from the public.

“Previously the verbal abusive was due to the nature of the situation, but more often we are finding it’s due to the long wait times,” Brina said.

“Unfortunately, there still is the public perception that when someone calls for help, there is an available ambulance, so our EMDs need to be that calm reassuring voice which explains the delay.”

Brina said call takers receive substantial training designed to reduce caller aggression.

Brina said even recently in Cairns a verbally abusive caller was reported to police and was subsequently charged with eight offences including using a carriage service to menace, harass or cause offence, and threatening sabotage – all offences under the criminal code.

Brisbane Operations Centre Acting Director Matt Salter agreed with Brina and said OpCen staff were reasonably resilient and didn’t take a lot of callers’ responses too much to heart.

“Our call takers understand these people are in crisis and they feel vulnerable, which can result in quite heightened behaviour,” Matt said.

“But if they receive calls where someone threatens them personally, or their families or colleagues, then that’s when they struggle.”

Click here to listen to an example of a call received recently at the Brisbane OpCen.

Matt said the call taker did an exceptional job.

“In this case, thankfully the patient was ok,” Matt said.

“When people are heightened and are being difficult about giving us the information we need, this just means it delays our response – we also need to assess the safety at the scene for both the patient, and our paramedics.”